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� ' <br /> � � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> , FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Zq�t p f=o x 3•r— <br /> PID: <br /> DESCRIPTION OF WORK: �tGw R•cs + ��+�r� � e <br /> _�_ ____ -- _-s-- ------------------------------------------------------------ <br /> ZO.�i G REV�W BY: DATE APPROVED: � -S-o f <br /> BUILDING REVIEW BY: DATE APPROVED: i� - S'-o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEW � Yes r/ No SEWER CO�TNEC"ITON <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes . No _� PARK FEE <br /> SAC Yes No _�� � " SITEINSPECTION <br /> Number of SAC�Units ��a� OTHER (specify) <br /> ZOYIt�iG CH�CK LIST Zoning District: <br /> Fire Departmenr. Post Office: School District: <br /> Lot Area: Sq.ft. Acres �•9� Width 3 Z�t•` Depth I o S d.65 . <br /> Survey Submitted: Yes� No Date of Survey: 'i-�q -�S <br /> Proposed Setbacks: �s� i4�M,G t <br /> Front (Lake): Z� o Right Side: '{S•�2 1 <br /> Reaz(Street): 335 Z�� Left Side: 1 bg 'a3 <br /> Adjacent Structures: �$�(�qTL,rt,� Wetland: [�0� <br /> Building Height: Def. Hgt. Z� � Peal:Hgt. 33� <br /> Lot Covera�e: N I A <br /> Grading: Staff Approval Date: �-�(;.o S By: �(�� Council Approval Date: � <br /> Septic: Staff Approval Date: 7-z7- oS � By: W G• <br /> Zoning File: # — Resolution: # �"' Resolution Date: <br /> Shoreland District: ^f v <br /> Av;. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REv1ARKS (in house): <br />